How do you manage a patient with decreased but residual PET activity following concurrent chemoRT and PCI for limited stage SCLC?

I agree with @Dr. First Last. There are too many false positive PET scans in the mediastinum. There is no effective second line therapy. Only under the rarest of situations would we consider biopsy to prove this is persistent SCLC and consider surgical resection. The best advice I could give would be NEVER obtain a post chemoXRT PET scan in SCLC.

I think I was the last to know that PET was OK in initial staging, and I will be the last to think PET is worth the price in re-stage. Until we find curative salvage for SCLC, early detection of recurrence or residual is not worth the price. And applying a “treat oligometastasis” argument does not hold up under scrutiny.